Thursday, February 24, 2011

Last Night's Confession

Last night I went to my mental health peer support group. I talked about my therapist. I don't know if there will be any consequences for him.

One of the participants was a person who works for the state of Vermont mental health department. She said that the way my therapist acted, he would get his license yanked. I don't want to be the cause of him loosing his license. When I came home I was deeply conflicted about making my confession. But I learned something at peer support. My therapist should have neither told me that he sees a therapist every Monday, nor that he was fired from a job. Both are too much information about his personal life. The state worker told me in the parking lot, because she didn't want to say it in front of the others, that perhaps the reason my therapist does not bill me is because he sees our relationship as personally rewarding and reciprocal, a kind of peer situation. I do know that he will briefly discuss other patients with me. I didn't tell her that. Their identity is always secret, just the facts of their illness is discussed and I give him feedback. But I rather think that he hasn't billed me because he is confounded by the paperwork needed to get Medicare payments. A disorganized man without a bookkeeper working for his practice. Trying to do all the billing himself. But the peer group did say that he should not have been asking me for a painting as payment for therapy, that there is Medicare to take care of payment. I told the group that Medicare pays about $34 per session, and someone noted that the average fee for therapy is usually $70 to $90, for someone with his title. So this must be the reason why finding a therapist who takes Medicare is hard.

I told my husband after group that I wanted to cry for what I had done, outing my therapist. One of the members of the peer support group is also his patient, but this person is so sick (with schizophrenia) that I don't think he has a clue we see the same therapist. What hints I may have inadvertently dropped go right over his head. However, his good friend in the group, a fellow he likes to go out and see movies with, is sharper and may know about the connection.

So, does the state worker keep email records and did she keep the name and phone number of my therapist that I emailed her six months ago with the suggestion that she refer a client to him? Will she break group confidentiality and try to go after my therapist's license? Its a long shot because she's pretty busy with other matters. Or will the friend tell his friend "Hey, did your therapist ever tell you he loved you because you've got the same therapist as Karen".

My husband was very supportive of me, gave me a big hug when I came home and he said, "I think your therapist is headed for a nervous breakdown." Why I asked. "Because he's doing things that are socially self destructive" he replied. And I thought about it, and realized that maybe my husband is right. Personally I think my therapist's ego is sound and he enjoys his own state of corruption, but it is a point to bring up with my therapist and a way to attack the issue that I feel comfortable with. I can ask my therapist if he is in danger of having a nervous breakdown, that this is what my husband thinks in light of someone saying I love you to his wife and a teenager. But I also think it was wrong for him to say I love you to me because I'm not in a position to say "I love you" in return to my therapist. I can show my affection, but I can't say those words to him. Its like knowing that you can be emotionally intimate in safety, because nobody is going to do something stupid like take off their clothes. You have to feel safe for that hour of being "the real you" because when you leave there are no consequences to what transpired. Therapy is all about freedom, and because of that, there has to be rules. I follow the rules. But I know that in life I have not always followed the rules. I left one marriage to take up with a different husband. I broke rules of fidelity. I'm not going to throw stones at my therapist because he has trouble following the rules. For the most, I'm confident that he is well aware of the rules, even though with me he unwisely bends them.

I have an email buddy who is male, several years younger than me, and suffering from schizophrenia and alcoholism, who I occasionally sign off with an "I love you". Usually I just sign our mail "Hugs". Am I wrong in saying I love you to him? I don't think so, it is just the emotion I sometimes feel, especially when he has had a brush with suicide or a hospitalization. When he might be especially down, that is when I want to give him my total emotional support. I've been in email correspondence with him for about seven or eight years and send him Christmas presents every Christmas.

Cherry Blossom is lying asleep across my sock covered feet. I don't care if they say its a dominance gesture and that the dog is really trying to be superior. I love her warmth, and the feel of the weight of her little body. If in all the kitchen, this is the place it pleases her to rest, the safest port in the harbor, then I'm touched.

However, I know I cannot say "I love you" to my friend "R". She suffers from paranoid schizophrenia and it is part of her disease that she mis-interprets and re-invents ordinary events with a sexual twinge. In fact she has admitted to me that she is happy that both her best friends have either a husband or a boyfriend, because this means that they won't be going after her! She told me once, about the little old ladies in her church, that they were very horny and to watch out because they could be after you for sex! Little old ladies! Or there was the instance of a knock on her door, late at night. I interpret this as a person who is lost and knocking on the wrong apartment door, she interprets this as being a man who thinks she's a whore and is looking for sex! Of course she doesn't answer the door because she knows she's not a whore and doesn't want to have sex with him! Why, she asks me, do the voices tell me I'm a whore, when I've been celibate for over twenty-five years?

I do believe that in cards to each other, we sign our names under the word love, but I don't dare push the point. She's been my friend for just about twenty years, and I have to show my affection in round about, innocuous ways, like saying "I'm so happy I can say anything to you" or "your so smart" or "there's nobody in the world like you". Still, it wouldn't surprise me if "R" heard voices telling her that my husband and I wish to get her in a threesome. "R" has enough hold on sanity that she can ignore these voices. Although she treats me with nothing less than respect and kindness, she may have suspicions that I'm up to no good that she hides. Reality is twilight for her, and she doesn't trust her ears or her eyes, for she knows that sometimes they lie to her. To her therapist she says "I don't know for certain that I am siting in a room with you." And while the therapist tries to convince her of the basic fact that this is something she can believe, "R" will answer, "anything could be true, anything could be false". That is her motto in life. I am rather proud of her navigating such a horrid condition of not knowing, and acting for the most part, simply like a sensible person going about doing the ordinary chores of living. At times her sense of humor takes a vulgar twist that leaves me speechless, but I suppose that this is a consequence of having sex on your brain most of the time.

It is very easy to sign my emails and Christmas cards to the little old ladies at church with the word "Love". And I do have great affection for them, and I know that being great dames, they can handle a little reverence and respect and worship from someone who is like a child to them.

Today spent two hours drawing ivy leaves, will do the same again tomorrow morning and hopefully finish up the drawing. I hope whomever gets the painting appreciates that fact that no two ivy leaves are the same! The ivy is covering a brown rock cliff face, which will have to be painted in first, and then maybe the ivy leaves painted in after in white, so that the transparent oils show true greens and yellows as a third coat of paint over the white! For a color to truly pop, it needs white underneath, and sometimes, two or three coats of the same color. I know, with all these ivy leaves, I'm setting myself up for a lot of work. Will take a photograph of the drawing and post it here (along with an ivy leaf count!).


  1. Dear Karen,

    I'm sorry I haven't been around lately. I've been struggling a bit with depression, anxiety and the voices. I asked my psychiatrist if the voices would ever go away and he said quite simply -- No, that he knew of people in their 90s who still hear voices. That was rather depressing. Then my therapist, who was concerned because my voices had been acting up as I re-read some older journals, said that I could go back into acute psychosis even while I took my medications and continued with therapy. More depressing thoughts...

    I've had the same therapist since I first got ill in 1998 and she has been very helpful to me, but she definitely sets boundaries which I respect. I realize that being a therapist you have to be very careful not to get too personal because actually both therapist and patient are in a vulnerable position. I have had the wish that she could be my friend, but really she is not and probably never will be, even if I stopped therapy with her. All this distance acts as a safeguard by taking pressure off both of us. It's not a perfect relationship, but it is a good one. For 50 minutes every other week I have her complete attention and I know she cares too.

    Then again your therapist has helped you greatly by curbing your suicidal thoughts and instincts. No one is perfect and he sounds like he has a good heart and means well. Just continue to be cautious. It is not your responsibility to take care of your therapist, he needs to learn how to to that for himself.

    You are a good woman Karen to be so concerned for him, but you must take care of yourself and your needs first and foremost.

    It may not be appropriate for a therapist to say "I Love You." but I do think it is fine for friends to express deep affection and so I will continue to say to you,

    All my Love,

    Kate : )

  2. Karen, I am new to your blog, but it does sound to me like your therapist is crossing appropriate boundaries by saying, "I love you" to a client. They really are not supposed to do that. However, I think you are right in assuming perhaps the therapist is having his own mental health problems. Like Kate said, though, it's not your job to take care of your therapist or worry about his mental health.

    If I were you, I would consider how much I liked talking to this therapist and how helpful it was compared to how uncomfortable he made me feel. If he makes you uncomfortable, he's probably not the best therapist for you. There are many therapists out there. However, as far as paying for them with Medicare that is actually a problem because like your friends told you, Medicare doesn't cover the entire cost for therapy with most people.

    The route I take to get therapy with Medicare is that I go to the local community mental health center. There, they do not bill me for the costs that Medicare won't pay. They simply bill Medicare. Private practice therapists don't usually do that; they generally charge you for the portion that Medicare won't pay, at least as far as I know.

    If you have a community mental health center near you, that might be a good place to go if you decide to look for a different therapist. If you have Medicare, you can go to one of those. Sometimes there is a waiting list to get in; that is one drawback.

    I hope you figure out what to do about the therapist, and definitely keep in mind that they do have professional boundaries they are not supposed to cross, so if he does anything else inappropriate, it would probably make sense to look for someone else.

    By the way, I like your blog!

  3. Hi Karen,

    I just wanted to let you know you are the recipient of an "I Choose to Live" Award from my blog. It is something I give out to blogs I come across or ones that are recommended to me by people who have thought about or attempted suicide at some point, but choose to live despite mental illness. I found your blog through Kate. If you go to this page, you can copy the graphic at the top of the page and put it on your blog if you would like to. There is a description of your blog there too:


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